Barcellona MG1, Biermann S1, Wilkinson R1, Znaor-Wassall N1, Sadler E2
1King's College London, Academic Department of Physiotherapy, London, United Kingdom, 2King's College London, King’s Improvement Science and Centre for Implementation Science, London, United Kingdom
Background: Anterior cruciate ligament injury (ACLI) is a common knee injury associated with pain, functional disability, high healthcare costs and subsequent osteoarthritis. Recent research suggests that approximately 50% of individuals may respond well to conservative (non-surgical) management (CM). Rehabilitation following the surgical management of ACLI is well researched with clinicians able to access evidence-based guidelines for post-surgical rehabilitation. There is limited evidence for the rehabilitation of individuals who opt for CM. This has led to significant variation in clinical practice.
Purpose: As part of a larger body of research to develop an optimal treatment package for the CM of ACLI this study explored the beliefs, attitudes and opinions of physiotherapists regarding the CM of ACLI; including their perceptions of surgical versus non-surgical management, the use of guidelines and outcome measures, return to sport, discharge and onward referral criteria, and patient specific considerations.
Methods: Semi-structured interviews were conducted by three MSc physiotherapy students with a purposive sample of 13 chartered physiotherapists currently managing patients with ACLI in the UK. A topic guide was developed by the research team, which included a social scientist and consultant physiotherapist in musculoskeletal. Interviews were audio recorded, transcribed and analysed using a thematic analysis approach to examine emerging themes, which involved independent analysis followed by group discussion within the research team to reach consensus on the main themes and related subthemes.
Results: Physiotherapists worked in various settings: National Health Service (NHS) (n=5), private (n=3), sports (n=3) or mixed (n=2) setting(s). Identified themes and related subthemes pertaining to the views of the physiotherapists were: 1) Sociocultural contexts affecting decision making (role of the surgeon; wider sociocultural influences); 2) Discord between the aspiration and reality of individualised patient care (practice setting / environmental constraints; factors influencing use of evidence-based guidelines and psychosocial outcomes); 3) Type of patient (professional categorisations; patient categorisations); and 4) Changing nature of decision making in the context of longer-term management (changing nature of therapist-patient relationship shaping shared decision making; expectations of patient recovery over time).
Conclusion(s): Physiotherapists perceived that some people with ACLI could be successfully managed conservatively. The preferred treatment pathway was deemed to be shaped by medical professionals, family, friends and wider societal perceptions. The use of outcome measures to assess for psychological factors related to CM was limited. Physiotherapists voiced that they largely relied on previous experience or post-surgical rehabilitation guidelines to formulate treatment plans. The majority also considered that the nature of the therapeutic relationship changed from a predominantly paternalistic model of care earlier in treatment, towards a more shared decision-making model later in the rehabilitation process, as both therapy and patient goals changed over time. The extent to which treatment was individualised was dependent on the care setting.
Implications: The findings from this study will be used as part of a larger body of research to inform the development of an evidence-based treatment package for the conservative management of patients following ACLI.
Keywords: Anterior cruciate ligament, Conservative management, Qualitative
Funding acknowledgements: Not applicable
Purpose: As part of a larger body of research to develop an optimal treatment package for the CM of ACLI this study explored the beliefs, attitudes and opinions of physiotherapists regarding the CM of ACLI; including their perceptions of surgical versus non-surgical management, the use of guidelines and outcome measures, return to sport, discharge and onward referral criteria, and patient specific considerations.
Methods: Semi-structured interviews were conducted by three MSc physiotherapy students with a purposive sample of 13 chartered physiotherapists currently managing patients with ACLI in the UK. A topic guide was developed by the research team, which included a social scientist and consultant physiotherapist in musculoskeletal. Interviews were audio recorded, transcribed and analysed using a thematic analysis approach to examine emerging themes, which involved independent analysis followed by group discussion within the research team to reach consensus on the main themes and related subthemes.
Results: Physiotherapists worked in various settings: National Health Service (NHS) (n=5), private (n=3), sports (n=3) or mixed (n=2) setting(s). Identified themes and related subthemes pertaining to the views of the physiotherapists were: 1) Sociocultural contexts affecting decision making (role of the surgeon; wider sociocultural influences); 2) Discord between the aspiration and reality of individualised patient care (practice setting / environmental constraints; factors influencing use of evidence-based guidelines and psychosocial outcomes); 3) Type of patient (professional categorisations; patient categorisations); and 4) Changing nature of decision making in the context of longer-term management (changing nature of therapist-patient relationship shaping shared decision making; expectations of patient recovery over time).
Conclusion(s): Physiotherapists perceived that some people with ACLI could be successfully managed conservatively. The preferred treatment pathway was deemed to be shaped by medical professionals, family, friends and wider societal perceptions. The use of outcome measures to assess for psychological factors related to CM was limited. Physiotherapists voiced that they largely relied on previous experience or post-surgical rehabilitation guidelines to formulate treatment plans. The majority also considered that the nature of the therapeutic relationship changed from a predominantly paternalistic model of care earlier in treatment, towards a more shared decision-making model later in the rehabilitation process, as both therapy and patient goals changed over time. The extent to which treatment was individualised was dependent on the care setting.
Implications: The findings from this study will be used as part of a larger body of research to inform the development of an evidence-based treatment package for the conservative management of patients following ACLI.
Keywords: Anterior cruciate ligament, Conservative management, Qualitative
Funding acknowledgements: Not applicable
Topic: Musculoskeletal: lower limb; Musculoskeletal: lower limb; Sport & sports injuries
Ethics approval required: Yes
Institution: King's College London
Ethics committee: KCL Research Ethics Committee (BDM Research Ethics Panel)
Ethics number: LRS-17/18-6589
All authors, affiliations and abstracts have been published as submitted.
